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Purpose: To investigate the trends in health-related quality of life and health service use associated with diabetes and/or major depression in South Australia from 1998 to 2008. Methods: Data analyzed were from 9,059 persons aged ≥15 years who participated in representative surveys of the South Australian population in 1998, 2004 and 2008. Major depression was determined using the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Diagnosed diabetes and health service use were determined by self-report. Health-related quality of life was assessed using the 36-item Short-Form Health Survey (SF-36) and the 15-item Assessment of Quality of Life (AQoL) instruments. Socio-demographics (including mental health literacy), arthritis, asthma, osteoporosis, and obesity covariates were determined by self-report. Weighted age-standardized and multiple covariate-adjusted means of dependent measures were computed. Results: The prevalence of diabetes only, major depression only, and comorbid diabetes and major depression increased by 3.0 (74%), 2.6 (36%), and 0.4 (53%) percentage points, respectively, from 1998 to 2008. Mean health-related quality of life scores were 9 to 41% lower (worse), and health service use was 49% higher for persons with comorbid diabetes and major depression than for those with diabetes only (all P values <0.05) independent of all covariates, consistently over the 10-year period. Conclusions: If past trends continue, our results suggest that the increased population health and economic burden of comorbid diabetes and major depression could persist over the next decade or so. These trends have important implications for making health policy and resource allocation decisions. [ABSTRACT FROM AUTHOR]

Background: Women who have had gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes. Early detection and management of type 2 diabetes are important for reducing associated complications and costs. Aims: To evaluate an existing register for long-term follow-up of women who have been diagnosed with GDM. Methods: Recruitment to the GDM Recall Register began at the diabetes centres of two hospitals in South Australia from July 2002, and was expanded to include a third hospital from September 2005. Women enrolled on the Register are sent an annual letter reminding them that they are at increased risk of developing type 2 diabetes and encouraging them to get their blood glucose checked. An update form is also included for women to complete and return to the Register. Results: As at 30 June 2009, 817 women were enrolled on the Register. Of women diagnosed with GDM at the participating hospital sites, recruitment to the Register was 68.4% in 2002 and 64.4% in 2007. Of the 429 women who had been sent their first reminder letter, 46.4% had returned the update form. Of these, 56.3% had undergone a glucose test for diabetes. Two women reported developing type 2 diabetes. Conclusions: Expansion of the GDM Recall Register is likely to result in increased opportunities for early detection of diabetes for this high-risk group in South Australia, therefore allowing earlier intervention and treatment to prevent or reduce serious, costly diabetes-related complications. [ABSTRACT FROM AUTHOR]

The article presents the North West Adelaide Health Study (NWAHS), which represents a longitudinal study of 4060 adults ages 18 years and above at the time of recruitment. The goal of this study is to provide data to assist in maximising the effectiveness of strategies being used to prevent, detect and manage chronic conditions. It notes that this study formed the basis for the Nutrition, Obesity, Lifestyle & Environment (NOBLE) Study.

Summary: Background: To determine the contribution of overweight and obesity to five chronic conditions using the population attributable risk (PAR) statistic. Method: Self-reported data were collected in Australia using a representative, ongoing monthly risk factor surveillance system using computer assisted telephone interviewing (CATI) for the period 2004–2006 (n =15,261). The PAR, adjusted for various demographic and health-related risk factors, was used to determine the contribution of overweight and obesity to diabetes, asthma, cardiovascular disease (CVD), arthritis and osteoporosis for people aged 18 years and over. Results: In total, 19.0% of South Australians aged 18 years and over were obese, and 36.0% were overweight. The PAR of overweight and obesity was highest among those with diabetes (17.3% and 28.4%). After adjusting for demographic and risk factors, overweight and obesity had a significantly high PAR for diabetes (11.3% and 23.1%), asthma (4.0% and 10.3%) and arthritis (6.7% and 8.1%). The unadjusted PAR of overweight and obesity for CVD was significant (10.8% and 11.7%) but was reduced when controlled for other factors. The PAR of overweight and obesity was significant for osteoporosis but the association was protective. Conclusions: The use of PAR contributes to the understanding of how overweight and obesity are related to various chronic conditions however the size of this association depends on the chronic disease and other socio-demographic and health-related risk factors that may or may not be modifiable. The information provides evidence of the association of overweight and obesity with chronic disease and the potential for reducing the burden of chronic disease by addressing the obesity epidemic. [Copyright &y& Elsevier]

Background: Diabetes and its associated complications are part of a chronic disease global epidemic that presents a public health challenge. Epidemiologists examining health differences between men and women are being challenged to recognise the biological and social constructions behind the terms 'sex' and/or 'gender', together with social epidemiology principles and the life course approach. This paper examines the epidemiology of a population with diabetes from the north-west metropolitan region of South Australia. Methods: Data were used from a sub-population with diabetes (n = 263), from 4060 adults aged 18 years and over living in the north-west suburbs of Adelaide, South Australia. Eligible respondents were asked to participate in a telephone interview, a self-report questionnaire and a biomedical examination. Diabetes (undiagnosed and diagnosed) was determined using self-reported information and a fasting blood test administered to participants. Data were analysed using SPSS (Version 10.0) and EpiInfo (Version 6.0). Results: Factors associated with diabetes for both men and women were being aged 40 years and over, and having a low gross annual household income, obesity and a family history of diabetes. In addition, being an ex-smoker and having low cholesterol levels were associated with diabetes among men. Among women, having a high waist-hip ratio, high blood pressure and reporting a previous cardiovascular event or mental health problem were associated with diabetes. Conclusion: The results found that men and women with diabetes face different challenges in the management of their condition. Public health implications include a need for quality surveillance data, including epidemiological life course, social, behavioural, genetic and environmental factors. This will enrich the evidence base for health promotion professionals and allow policy makers to draw inferences and conclusions for interventions and planning purposes. [ABSTRACT FROM AUTHOR]

Objective: To compare Medicare-related costs and service utilisation of people with diagnosed diabetes, asthma or chronic obstructive pulmonary disease (COPD) to those who were previously undiagnosed, and those without these conditions. Design, setting and participants: Representative cross-sectional study of people (18+ years) living in the north-west area of Adelaide. Participants were recruited by telephone interviews. Biomedical and self-report data for 2352 participants were linked to Medicare Australia Medicare Benefits Schedule (MBS) data from 1997 to 2002. Main outcome measures: Mean number and cost (benefit paid) of MBS services for people with diagnosed and previously undiagnosed diabetes, asthma, and COPD, and those without these conditions. Results: Mean (± SD) MBS costs were significantly greater for people diagnosed with diabetes ($4205 ± 2596), asthma ($3307 ± 2542), or COPD ($3779 ± 2529) than for those without these conditions. MBS costs for people with asthma or COPD that had not yet been diagnosed were also significantly higher than for those without these conditions, although this was inconsistent across financial years. Conclusions: Diabetes, asthma, and COPD are costly conditions in terms of health service use. Costs associated with undiagnosed asthma and COPD are similar to their diagnosed states. Prevention of progression along each chronic disease continuum is likely to reduce costs. [ABSTRACT FROM AUTHOR]

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Objective: To assess the management of patients with type 2 diabetes mellitus in the primary care setting, with respect to risk factors associated with coronary heart disease., Design: Retrospective cross-sectional audit., Setting: Specialised diabetes assessment clinic in a tertiary referral teaching hospital., Participants: 328 patients with type 2 diabetes mellitus (mean age, 58.3 years [95% CI, 57.5-59.1]) and no existing coronary heart disease (CHD) referred to the clinic by general practitioners during 2004-2005., Main Outcome Measures: Comparison of glycated haemoglobin (HbA(1c)), systolic blood pressure and total cholesterol levels and smoking frequency with current RACGP (Royal Australian College of General Practitioners) targets (< 7.0%; < 130/80 mmHg; < 4 mmol/L; and smoking cessation, respectively). Estimation of patients' 10-year absolute risk of CHD events using the United Kingdom Prospective Diabetes Study risk engine, and its relation to primary prevention of CHD., Results: 42%, 61% and 43% of patients were receiving medication to treat hyperglycaemia, hypertension and hypercholesterolaemia, respectively; 46%, 29% and 15% of patients, respectively, had [corrected] achieved the recommended RACGP target values for HbA1c, blood pressure, and total cholesterol; and 22% of patients were current smokers. The mean 10-year absolute risk of CHD was 16.8% (95% CI, 15.7%-17.9%), and 48% of patients were classified as "high risk" (absolute risk, > 15%). Based on the 10-year absolute risk, there was no difference between high- and low-risk groups with respect to prescription of aspirin, statins or angiotensin-converting enzyme inhibitors. If all the recommended RACGP goals were achieved, the mean 10-year absolute risk would decrease to 12.6% (95% CI, 11.8%-13.4%)., Conclusions: Recommended treatment targets are not being uniformly achieved. Medication for primary CHD prevention is not being preferentially directed at those patients at highest risk, based on the estimated 10-year absolute risk of CHD events. Our findings suggest new initiatives are required in the way target goals and primary CHD prevention measures are set for patients with type 2 diabetes mellitus.

Objective: To examine the association of health status with stage along the diabetes continuum., Design, Setting and Participants: Self-reported health status (SF-36) was assessed in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Impaired fasting glucose (IFG), undiagnosed diabetes, diagnosed diabetes, glycaemic control and cardiovascular disease were determined from fasting blood and self-reported data., Results: The prevalence of diagnosed diabetes was 5.6% (95% CI: 4.9-6.3), with an additional 1.0% (95% CI: 0.7-1.4) previously undiagnosed. When compared to those with normal glucose, those with diabetes were significantly impaired on all SF-36 dimensions except Mental Health, and those with IFG (4.3%) were significantly impaired in terms of Physical Functioning and Bodily Pain when controlling for the effects of age, sex and cardiovascular disease. Poor glycaemic control (HbA1c >or= 7.0%) was also associated with impaired health status., Conclusions: Health status is impaired not only among those with diagnosed diabetes but also those with IFG and undiagnosed diabetes.

Background: Analysis was undertaken on data from randomly selected participants of a bio-medical cohort study to assess representativeness. The research hypotheses was that there was no difference in participation and non-participations in terms of health-related indicators (smoking, alcohol use, body mass index, physical activity, blood pressure and cholesterol readings and overall health status) and selected socio-demographics (age, sex, area of residence, education level, marital status and work status)., Methods: Randomly selected adults were recruited into a bio-medical representative cohort study based in the north western suburbs of the capital of South Australia--Adealide. Comparison data was obtained from cross-sectional surveys of randomly selected adults in the same age range and in the same region. The cohort participants were 4060 randomly selected adults (18+ years)., Results: There were no major differences between study participants and the comparison population in terms of current smoking status, body mass index, physical activity, overall health status and proportions with current high blood pressure and cholesterol readings. Significantly more people who reported a medium to very high alcohol risk participated in the study. There were some demographic differences with study participants more likely to be in the middle level of household income and education level., Conclusion: People with risky behaviours participated in this health study in the same proportions as people without these risk factors.

Objectives: To determine the proportion of a representative population sample of adults in South Australia who have a body mass index (a measure of overall obesity) classified as normal or underweight, but who also have a waist circumference or waist hip ration (measures of central obesity) that indicates obesity., Methods: A representative population sample of adults aged 18 years and over living in the north west region of Adelaide (n = 2523) were recruited to the study. Clinical measures of height, weight, waist and hip circumference were obtained and used to determine body mass index, waist hip ratio and waist circumference., Results: Among women with a normal body mass index, 19.0% had a high waist circumference (> or = 80 cm) and 8.5% had a high waist hip ratio (> 0.85). Among males with a normal body mass index, 3.4% had a high waist circumference (> or = 95 cm) and 0.1% had a high waist hip ratio (> 1.0)., Conclusions: Body mass index, waist hip ratio and waist circumference all have a role in the identification of those who are obese or overweight.